Boston—Hospital clinicians might complain about how long it takes to reconcile a patent’s medication list in an electronic health record system, but a new report suggests the extra effort is worth it.

In a study released early by Diabetes Care, researchers looked at medication-review activities at Brigham and Women’s Hospital and Massachusetts General Hospital, both in Boston.

Lead author Alexander Turchin, MD, MS, emphasized the importance of reconciliation. “Lists of medications often don’t match what the patient is actually taking,” Turchin said. “Data entry errors, as well as medications prescribed by other practitioners that we’re unaware of, can cause those discrepancies.” 

Omissions, duplications, improper doses and drug interactions can send patients back to the hospital—or worse, the study team noted.

The issue is especially acute for diabetes patients, who have outsized risk for adverse reactions caused by improper dosages and inappropriate coadministration of medications, the report emphasized. An example provided was that incorrect dosing of medications like insulins and sulfonylureas can result in hypoglycemia, which might cause seizures, loss of consciousness or even death.

For the retrospective cohort analysis, researchers focused on adults taking at least one diabetes medication who were being treated in primary-care practices affiliated with the academic medical centers between 2000 and 2014. The study assessed how the fraction of outpatient diabetes medications reconciled over a 6-month period affected the composite primary outcome of combined frequency of emergency department (ED) visits and hospitalizations over the subsequent 6 months.

Results indicated that, among 261,765 reconciliation assessment periods contributed by 31,689 patients, 176,274 (67.3%), 27,775 (10.6%), and 57,716 (22.1%) had all, some, or none of the diabetes medications reconciled, respectively. 

Furthermore, the report noted, patients with all, some, or no diabetes medications reconciled had 0.354, 0.377, and 0.384 primary outcome events per 6 months, respectively (P <.0001). 

The study emphasized the importance of reconciliation, pointing out that, in a multivariable analysis adjusted for demographics and comorbidities, having some or all versus no diabetes medications reconciled was associated with a lower risk of the primary outcome (rate ratio 0.94 [95% CI 0.90–0.98; P = .0046] versus 0.92 [0.89–0.95; P <.0001], respectively). 

“A higher fraction of reconciled outpatient diabetes medications was associated with a lower frequency of ED visits and hospitalizations,” study authors conclude. “Individual performance feedback could help to achieve more comprehensive medication reconciliation.”

When that occurred, the researcher found that “introduction of feedback to individual providers was associated with a significant increase in the odds of all diabetes medications being reconciled (2.634 [2.524–2.749]; P <.0001).”

Turchin said that, extrapolating the findings, the study posits that reconciling diabetes medications could save up to $6.7 billion annually—8% of the total annual cost of hospitalizations of diabetes patients in the United States.

“Our results suggest that reconciling diabetes medications could improve patient outcomes and decrease health care costs,” he added.
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